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A COVID-19 Dilemma:  Where are all the PPEs?

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tnbutterfly - Mary is a BSN, RN and specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

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Do you have enough PPE?

Summary: While the rapidly spreading Coronavirus is frightening, healthcare workers across the United States are terrified by the lack of adequate supplies of appropriate PPE to protect them while they continue to fight the Covid-19 battle.

A COVID-19 Dilemma:  Where are all the PPEs?
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The deadly Coronavirus Pandemic has evolved into a much faster-growing monster than anticipated by many, infecting more than anyone could imagine. Hospitals are filling up with Coronavirus patients. ICU beds and ventilators are in short supply. As frightening as the virus is, the doctors and nurses on the front line of care are worried more about the lack of adequate personal protective equipment including N95 masks, surgical gowns, gloves, and eye gear. Without the proper protection, doctors and nurses are risking their lives daily as well as endangering their patients and their families as they care for those infected with the virus. Several healthcare professionals have already been infected; some have even succumbed to the disease.

This article is featured in the Spring 2020 issue of our allnurses Magazine...

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Recommended Protective Equipment

The Centers for Disease Control and Prevention recommends health care workers should wear protective gowns, gloves, goggles and masks while treating potential and confirmed cases of Covid-19 to avoid exposure. But, to add to the frustration of doctors and nurses, there has been some disagreement over which masks are needed. Previously, the CDC advised this use of tight-fitting respirators like the N95 or powered air-purifying respirators (PAPRs) which cover the entire head. In early March, the CDC updated its recommendation by saying that regular surgical masks are an acceptable option when examining or treating a coronavirus patient. More than likely, this change was based primarily on the "mask shortage" rather than on healthcare professional and patient safety.

Due to the shortage, many hospitals are requiring their staff to reuse their masks, whether it be surgical masks or N95 respirators many times, sometimes for up to 30 days, unless they become soiled.

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N95 masks are being reused indefinitely. Since I worked PACU I hadn't been sized, so I was given a one size fits all mask. We aren't sanitizing them. The plan is to throw them in a paper bag, and put them somewhere safe so we can use them again during the next shift.

Homemade Masks??

The CDC also stated the following:

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In settings where facemasks are not available, HCP might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and sides of the face.

As a result of this statement, mask-making groups popped up all over the country, trying to do what they could to help protect the healthcare providers.

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I feel like our government thinks this is adequate protection for us. And nothing will change until we die. And I don’t want to be one of the deaths.

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While I understand people’s wants and desires to help, I do not feel that these are acceptable alternatives. We might as well go in with no masks. I’d personally rather use my N95 for a week straight than a mask that offers virtually no protection.

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This shines a light on how the public truly has no understanding of virus transmission and how our medical protective gear works.

What scares me is that the government feels these are going to be acceptable for us and that Americans are answering the need for our healthcare workers, when they are not.

So what’s all the fuss about? Isn’t a mask a mask?

The FDA website offers a comparison of N95 respirators and surgical masks, both of which are examples of PPEs that are used to protect the wearer from airborne particles and from liquid contaminating the face.

Surgical Masks

  • Loose-fitting; does not provide complete protection
  • Help block large-particle droplets, splashes, sprays, or splatter that may contain viruses and bacteria
  • Does not filter or block very small particles in the air that may be transmitted by coughs, sneezes, or certain medical procedures (COVID-19 is a small-particle)
  • Not intended to be used more than once.

N95 Respirators

  • A respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles
  • Blocks at least 95 percent of very small (0.3 micron) test particles
  • The filtration capabilities of N95 respirators exceed those of surgical masks
  • Not intended for public use
  • Not intended to be reused

From the lists, you can see that nurses and doctors should be using a tightly fitted N95 respirator designed to keep out more particles.

Understanding the Difference.jpg

What’s Being Done to Get More Masks and Other Equipment?

Project Airbridge

A planeload of health care supplies arrived in New York City on Sunday, March 29, from China. This is part of an effort the White House says will expedite the arrival of goods that are badly needed to fight the coronavirus pandemic. According to a White House statement, the shipment included 130,000 N95 masks, nearly 1.8 million other face masks and gowns, more than 10.3 million gloves and more than 70,000 thermometers. This is the first of about 20 flights through early April for a public-private partnership it's called Project Airbridge.

Thank You

Hopefully, all healthcare professionals and frontline responders will receive what they need to provide protection for themselves, their patients, and their families while continuing this battle against a deadly Coronavirus. Until then, nurses will continue to show up and provide compassionate care...because that’s what nurses do. They are indeed heroes, and for that we thank you! Your service and dedication does not go unnoticed.

If you want to share your story, we have a special COVID-19 Disaster forum where you can safely and anonymously talk with other nurses.  You can also participate in our article contest - How is Covid -19 Affecting Your Life?

References

https://www.nytimes.com/interactive/2020/03/11/us/virus-health-workers.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html
https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-and-surgical-masks-face-masks
https://www.npr.org/sections/coronavirus-live-updates/2020/03/29/823543513/project-airbridge-to-expedite-arrival-of-needed-supplies-white-house-says

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14 Followers; 139 Articles; 202,007 Profile Views; 5,598 Posts

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HiddenAngels has 7 years experience.

138 Posts; 685 Profile Views

Where are the PPEs? Hidden in some locked drawer until the "big wave" hits.

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MunoRN has 10 years experience as a RN and specializes in Critical Care.

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To clarify , the CDC has never lowered their recommendations to anything other than respiratory level respiratory protection; N95 or higher which includes PAPR and other HEPA level filtration is still the recommended level of respiratory protection.

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by 2Ask Member

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Lesson learned: We should become less reliant on disposable PPE and come up with reusable options. Perhaps each nurse could aquire our own reusable mask -much like we do our stethoscope- but from a list of "approved" models.

I know of a hospital which is using reusable N99 masks on the COVID floors.

In between patients, the nurse wipes the exposed part of the mask down with purple top wipes. At the end of the shift, the nurse washes the mask with soap and water in preparation for use by the next shift. They attend an inservice and fitting.

The mask in use looks something like this:

P100.jpg

As for GOWNS: One hospital where I worked used washable isolation gowns which were washed in house in the laundry room, We can return to that and hire extra laundry personnel in an emergency.

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289 Posts; 1,556 Profile Views

I work at an FQHC, and I feel like clinics like ours are part of the answer to “where has the PPE gone?” Before Covid, we basically never used masks or gowns. Certainly not N95s. We were fit-tested, and about twice a year we’d have a patient suspected for TB, and one or two people would dig out an N95. Since this started, we are going through boxes and boxes. Gowns— I never wore a gown for the entire year that I worked here, but now we have several people gowned all day every day. A triage nurse and an MA stand in the lobby, gowned, and our Urgent Care staff are gowned all day. We have, finally, started using reusable washable gowns, but for the first several weeks we used disposable ones.
PPE is being used at an astounding rate, for legitimate reasons. I know it’s tempting to chalk the shortages up to “hoarding” or evil administrators hiding them. But if every clinic, doctors office, and dental office is now using gowns and masks as part of their daily work, when they didn’t before, that is a huge increase in usage.

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OUxPhys has 4 years experience as a BSN, RN and specializes in Cardiology.

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We should be able to buy our own reusable respirator masks so that nothing like this happens again in the future. It's obvious we cannot rely on the government nor our own employers to give us the appropriate PPE.

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289 Posts; 1,556 Profile Views

On 4/5/2020 at 9:00 AM, OUxPhys said:

We should be able to buy our own reusable respirator masks so that nothing like this happens again in the future. It's obvious we cannot rely on the government nor our own employers to give us the appropriate PPE.

This is a great idea and I’d like to get one after this is over. Just like my stethoscope; I can buy it with my own money and keep it somewhere for use when needed.

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